Sheila Motloung, 51, is staring death in the face after being denied life-prolonging kidney dialysis treatment by the state because of her age.
To survive, she needs a kidney transplant or the money for private treatment - both unlikely options.
Hundreds more South Africans could be in the same predicament as cash-strapped state hospitals apply strict criteria on who qualifies for dialysis.
Motloung, who suffers from renal failure and diabetes, has been denied dialysis at Chris Hani-Baragwanath Hospital or any other state hospital.
"It's sad to watch someone you love, who used to be so independent, reach a stage where they cannot even walk," said Motloung's daughter, Maki Motloung-Twala.
Once an outgoing and fun-loving person, her mother is now in constant pain and immobile, suffering from swollen legs and fingers, a condition associated with renal failure.
She is reliant on the help of Motloung-Twala and her 73-year-old mother, Mary.
For just under a month, Motloung-Twala has watched her mother's condition deteriorate, and she feels powerless.
"I have tried to convince the hospital to reconsider their decision, but without any joy."
In a letter to Motloung-Twala, Dr Arthur Manning, clinical director of Bara, said the hospital followed guidelines, "drawn up by the whole country's experts, which help us to identify which patients will benefit most from having dialysis".
The decision regarding Motloung was based on these criteria, he wrote.
A doctor in the unit, who did not want to be named, said state hospitals could give dialysis only to patients who were:
- South African citizens;
- Under 60 years;
- Under 50 if a diabetic;
- Not HIV-positive or suffering from any other lifespan-limiting disease (such as cancer).
"The cost of dialysis is very expensive," said the doctor.
"It costs R15 000 for one person to undergo dialysis for a month."
The doctor said Bara had already exceeded its limits:
"We have space for 140 people to be on dialysis but we are treating 160."
"Our financial resources and staff are being stretched beyond their limits. We are splitting at the seams."
"Rules are rules. If we move the goalposts, we will be facing a bigger problem," he said.
Where does this leave Motloung?
According to the doctor, Motloung has three options.
- Dialysis at a private hospital, for which she would need a deposit of up to R40 000 and then have to pay between R15 000 and R20 000 a month;
- She could try to obtain a kidney transplant, but organs were not readily available;
- She could do nothing, in which case she would get weaker and sicker within weeks or months "and eventually die".
Motloung-Twala has investigated the possibility of getting private dialysis treatment for her mother, but her prospects don't look good.
"I have been told that I would need at least a deposit of R21 000 upfront."
"I don't even want to think about what would happen if we cannot do anything. Already, when the phone rings at night I think that maybe it's the call I am dreading."
"I have seen how dialysis improved my mother's condition. I know it will help again," she said.
Motloung underwent dialysis twice a week for six weeks when she was first diagnosed with kidney failure, and her condition improved.
"We gave her the benefit of the doubt and we hoped she would recover to a point where her kidneys were operating at 30 percent," the doctor said.
"It looked like this was working, but then it went wrong again."
Dr Mignon McCulloch, secretary for the SA Renal Society, said that while personally they did not support the criteria for dialysis, they did understand that resources were limited.
McCulloch, a doctor in a renal unit of a state hospital, said she could understand the stress on both the patient and the doctor.
"Doctors find it extremely distressing to tell a patient they cannot go on dialysis because they do not meet the criteria."
She added that the situation had worsened over the past few years. "More people are needing kidneys but the organs are not available and it was therefore necessary to draw up criteria like these," she said.
Dr Mike Pascoe, president of the society, said the criteria were in place to help state hospitals deal with underfunding.
"This is not the first time a patient has been turned away. In fact, about five years go a patient who was turned away from a state hospital took the matter to the Constitutional Court."
"In that incident, the court ruled that while the state had an obligation to treat someone in an emergency situation, it was under no obligation to treat chronic conditions if it did not have the funds to do so," he explained.
In the United States, 1 000 people per million are on dialysis, and while no statistics are available for South Africa, the doctor from Bara said the statistics were comparable, except that in South Africa, one out of 10 patients who needed dialysis did not receive it.
"There is just not enough money to go around," he said.
McCulloch supported him, saying: "It's a major problem. Resources are so limited, and when the money runs out, you have to make some tough choices".
Simon Zwane, spokesperson for the Gauteng health MEC, said national criteria were used in all state hospitals and were based more on a person's medical condition than their age.
"The question of finances is looked at all the time but we believe we must focus on prevention to try to reduce the number of patients demanding this treatment," he said. - Health and Science Reporter.